Instability & dislocation

The ball and socket joint of the shoulder is a delicate balance of ligaments, cartilage, muscles and bones and when any of these tissues become injured or overstressed then the shoulder can become unstable and dislocate.

Shoulder instability means the joint moves more than it should or even dislocates totally, either at the front, back or bottom of the joint. Treatment will often depend on the cause of the shoulder instability and during your consultation with your London Shoulder Specialists consultant, they will try to identify the trigger event.

There are three broad categories that can cause instability and dislocation of the shoulder. First, there is traumatic dislocation, typically caused by a direct, forceful injury that may have torn the labrum which is the cartilage ring around the shoulder socket. This would usually be of a nature to require medical attention at the time and you will usually have been advised to wear a sling and undergo physiotherapy, but often the resultant instability does not resolve.

The second cause is multidirectional instability where the shoulder dislocates with very little force and it can happen through the day, depending on your activities. People with hyper-extension or increased joint laxity can suffer from this. Physiotherapy may be initially recommended to ensure the shoulder is kept in correct balance when performing a range of movements.

The third cause is positional non-traumatic dislocations and is the result of ‘abnormal’ muscle movement that allows the patient to dislocate the shoulders, usually both, by performing a particular movement such as lifting the arm above the head.

Lifestyle adjustments and the use of a shoulder support may help, but if instability continues, surgical intervention may be required. X-rays and MRI scans will identify the extent of the problem and CT scans are also used to assess bone damage.

Depending on the underlying cause this may be an open or arthroscopic procedure. For positional non-traumatic dislocations, thermal capsular shrinkage or plication may be recommended.

For more information on shoulder instability and dislocation and possible treatment options, please get in touch with the London Shoulder Specialists to arrange a consultation.